Written by: Drug treatment of breast cancer

Is drug treatment of breast cancer possible? As a doctor who has sat next to his patients for years and has heard the pulse of their worries and hopes, I can clearly state the answer: Yes, drug treatment can help in definitive treatment both in early stages and in advanced stages, it can control the disease and make life better. Drug therapy in breast cancer is not only "chemotherapy", today we use hormone therapy, targeted treatments, inhibitors of cell pathways and immunotherapy, each in its right place. What does drug therapy mean and what are its branches? ### Chemotherapy Medicines that stop cells from dividing irregularly. They may be used before surgery (neoadjuvant) to shrink the tumor or after surgery (adjuvant) to clear microresidues. Regimens are selected based on stage, age, general condition, and treatment goals. ### Hormone therapy (for ER/PR positive tumors) When a tumor responds to hormones, it slows down growth by reducing or blocking the effect of estrogen. Drugs such as tamoxifen or aromatase inhibitors are usually prescribed for 5 to 10 years and are the mainstay of hormone therapy. ### Targeted treatments Precise targeting of defective proteins and pathways in cancer cells: - HER2 positive: antibodies and antibody drug conjugates to target HER2. - HR+/HER2-: CDK4/6 inhibitors along with hormone therapy to slow down the cell cycle. - PI3K/AKT/mTOR: in selected patients to turn off growth switches. - PARP for carriers of certain hereditary mutations (such as BRCA) in certain scenarios. - Immunotherapy In some subtypes, especially triple negative (TNBC), selective directed activation of the immune system in combination with chemotherapy can produce more durable responses. When do we use medicines? ### Neoadjuvant (before surgery) To shrink the tumor, increase the chance of saving the breast and evaluate the actual response to the drug. In some biomarkers, targeted drugs or immunotherapy are also added to the combination. ### Adjuvant (after surgery) To reduce the risk of recurrence include short-term chemotherapy, long-term hormone therapy in HR+, and anti-HER2 therapy in HER2-positive. The exact plan depends on the stage, lymph node status, and individual risk factors. ### Metastatic disease The goal is to prolong survival with the greatest quality of life. Choices are personalized: from minimally invasive hormone therapy to targeted combinations and immunotherapy—based on biomarkers, symptoms, and patient preferences. What is the basis for choosing treatment? ### Biomarkers Tumor response is defined by ER/PR, HER2, Ki-67, and sometimes newer labels such as HER2-low. In some cases, molecular investigations (such as BRCA or PIK3CA mutations) make the drug pathway more precise. ### Genomic tests in premature HR+/HER2- In early hormone-positive tumors, some tests can tell us whether chemotherapy is necessary or hormone therapy will be sufficient; In this way, overtreatment is prevented. ### Personal status and life goals Age, menopause, co-morbidities, fertility, career, travel, family support and your personal preferences—all factor into the final version. Good therapy is your therapy, not a one-size-fits-all prescription. Common side effects and control methods ### Neutropenia and fever: The need to monitor blood count and refer in time. ### Nausea/vomiting: Effective antinausea protocols and simple dietary regimens. Fatigue and neuropathy: - Adjusting the intensity of daily activity, getting enough sleep, reporting to the doctor. - Cardiotoxicity in some periodic echocardiography targeted drugs. - Regular monitoring and clear communication make complications manageable. ### Fertility and pregnancy Consider fertility preservation before starting treatment. In pregnancy, the choices are more limited, but with careful planning, a safer treatment can be had. Breastfeeding and the time to return to pregnancy after treatment should be coordinated with the treatment team. Drug interactions and supplements Some heart medications, antidepressants, herbs, and even juices can interfere with treatments. Do not start any supplement on your own. **What should I expect from the treatment path?** Early: Stopping the disease and preventing it from returning. In Advanced: Long-term control, reducing symptoms and maintaining quality of life. ### Quality of life and support Proper nutrition, light physical activity, psychological support and honest discussions with the treatment team go hand in hand with medication. Successful treatment is not seen only in trials; It can be seen in your good mood. ### Multispecialty team Oncologist, surgeon, radiotherapist, pathologist, nurse, nutritionist and psychologist—a puzzle that together makes a better decision. Breast cancer today requires a personalized plan. Knowing your biomarkers, disease stage and priorities, we make a path through chemotherapy, hormone therapy, targeted therapies and immunotherapy; Sometimes for treatment in early stages and sometimes for smart control in advanced stages. Drug treatment is not only medicine; Knowledge is dialogue and companionship, and these three, when put together, turn hope from a word into an actionable plan. When are strengthening drugs and vitamins necessary in the treatment of breast cancer and when are they not? As a doctor who sits next to his patients every day, I say that supplements and vitamins are not "lone heroes"; But if they are added to the original version correctly and on time, they can reduce road fatigue and improve the quality of life. Our art is to draw a clear line between "what is useful" and "what is troublesome to be treated". ### The place of supplements in the treatment puzzle The main treatment of breast cancer is with anticancer drugs, surgery and/or radiotherapy. Supplements, if necessary, come in as a helper: filling deficiencies, helping bone and muscle health, supporting nutrition and managing some complications. ### The golden principle: Supplementation is not a substitute for treatment, and any decision should be coordinated with your current medical record and medications. ### Guardian of bones and immune balance - Its deficiency is seen in many people, especially in those who receive hormone therapy. - The exact dose should be determined based on the 25(OH)D test. - Irrational excess is as dangerous as deficiency, the doctor should specify the dose and duration. ### Calcium is the partner of vitamin D for bones - The goal is to provide the required daily supply of food + supplements. - If the diet provides enough calcium, there is no need for additional pills. - Drinking enough water and daily movement improves absorption and immunity. - B group vitamins, especially B12 and B6 (H3) - Substitution is useful in case of laboratory deficiency or neurological symptoms/fatigue. - "Very high doses" without indication have no added value and can even cause interference. - Antioxidant vitamins (C, E, etc.) ### Food antioxidants (fruits, vegetables, nuts) have priority. High doses of antioxidant supplementation during some chemotherapy/radiotherapy may interfere with their mechanism of action; Coordinate with the doctor about the time of use. ### Popular non-vitamin supplements - Omega-3 mild but calculated anti-inflammatory - Can help balance inflammation, heart and mood. - If you are taking blood thinners or surgery is coming up, be sure to coordinate the time of use with the treatment team. - Probiotics; When the bowel becomes more relaxed - In selected patients, it helps improve digestion and treatment tolerance. - Self-administration is not recommended during periods of severe neutropenia. - Plants and "pretentious naturals" (curcumin, ginkgo, ginseng, etc.) - Being "natural" is not the reason for being harmless. Some affect the metabolism of drugs or blood coagulation. - Inform the doctor before starting any herbal product. - Coenzyme Q10, selenium, zinc, etc., limited evidence, necessary caution - They may be used in documented deficiencies or special circumstances, but they are not necessary for "everyone". - The preference is with food; Supplement only when there is a deficiency or clear indication. - Important interactions that we should not ignore - Oral anticancer drugs (for example, CDK4/6, PI3K, etc.) interfere with some supplements and herbs; They change liver metabolism. - Blood thinners with high doses of omega-3, garlic, ginkgo, etc. may increase the risk of bleeding. - Grapefruit juice is incompatible with some drugs; If you are on medication, avoid this drink. - Carry the complete list of medicines, herbs and supplements with you in every visit; Medicinal honesty makes treatment safe. How to choose the right supplement? - Principles of safe shopping - Authentic brand, clear label, third party quality control approval. - Avoiding "miracle" promises and informal networks. - Lower dose and duration but effective - The goal is "minimum effective dose" and avoiding "very high doses". Adjust the timing with the time of taking anticancer drugs to minimize interference. Finally, you can contact Dr. Reza Pourriahi with the numbers listed on the site to receive advice and make an appointment.